1. The nurse wishes to learn more about the clients use of natural products and their effectiveness. The nurse consults the National Center for Complementary and Alternative Medicine because it is known that this center serves which function?

a.

Educates health professionals about complementary therapies

b.

Educates new mothers on the benefits of massage

c.

Engages in fundraising to offset client expenses with medical care

d.

Provides a scholarship for a student to study naturopathy

ANS: A

The purposes of the National Center for Complementary and Alternative Medicine (NCCAM) are to fund studies examining the effectiveness of various complementary therapies, advance knowledge about complementary therapies of health professionals, and serve as a clearinghouse for information about these therapies. It does not fund scholarships, nor is it a nonprofit organization. It focuses on advancing knowledge for health professionals rather than the general public.

2. A client is anxious about having a dressing change. Which statement indicates that the nurse is promoting appropriate complementary therapy?

a.

Ill call the doctor and ask for a larger dose of pain medication before the dressing change.

b.

As we begin the next dressing change, I want you to think of a beautiful, calm place where you feel happy and peaceful.

c.

Ill get another nurse to stay in the room with us during the dressing change so that you have a hand to hold during the procedure.

d.

Are you familiar with acupuncture? Its a very effective technique.

ANS: B

Because the clients primary problem is anxiety rather than pain at this point, the use of guided visual imagery should be the most effective intervention. Calling the physician for more pain medication and having another nurse present to help comfort the client will not address the main problem of the client. Acupuncture is used for relief of pain; an experienced practitioner is required to implement this technique.

4. A client who has been using which therapy requires the most immediate intervention by the nurse?

a.

Aromatherapy to treat depression

b.

Herbal preparations to treat hypertension

c.

Therapeutic touch to decrease level of pain

d.

Tai Chi to improve joint flexibility

ANS: B

The client who has been using herbal preparations to treat hypertension may have endangered his or her life by inadvertently ingesting a substance that interacts poorly with another drug or that can be toxic. Aromatherapy may be used as a complementary therapy to treat depression. Therapeutic touch has been shown to decrease pain, and Tai Chi may assist in mobility. These therapies are appropriate and are not life threatening.

5. A client scheduled for surgery has been taking garlic supplements. Which action is most important for the nurse to take?

a.

No action is necessary because the herbal agent is harmless.

b.

Notify the charge nurse that the client has been taking garlic.

c.

Note the information on the clients record and place in the chart.

d.

Notify the surgeon that the client has been taking garlic capsules.

ANS: D

Because garlic acts as an antiplatelet agent and has the potential to decrease clotting, much in the same way as aspirin, the surgeon will have to decide whether the surgery will be postponed. The nurse should never assume that any herbal supplement is harmless because many can interact with medications and diet. The nurse will note the information on the clients chart, but the most important action is to notify the surgeon. Informing the charge nurse about the garlic is not necessary if the surgeon is notified.

Middle-aged adult in a psychiatric facility with a history of schizophrenia

b.

Older adult client with end-stage lung cancer in hospice care

c.

Older adult client in a nursing home who is unresponsive

d.

Adolescent in a drug treatment facility with a history of violent outbursts

ANS: B

A client in hospice care may benefit from animal-assisted therapy because this type of therapy may decrease stress. A client in a psychiatric facility who has schizophrenia may not yet be stable enough to experience this type of therapy. A client who is unresponsive and is not interacting with the environment is not likely to benefit from this therapy. A client who is prone to violent outbursts would not be able to benefit from this type of therapy.

7. Which statement indicates that the nurse understands the risks associated with herbal preparations?

a.

Herbs are guaranteed to be safe and effective but are not necessarily natural.

b.

Herbs require a different type of prescription than is required for standard prescribed medications.

c.

Herbs are not classified as drugs and are regulated less strictly by the U.S. Food and Drug Administration (FDA).

d.

Herbs are guaranteed to be all natural and of high quality but are not necessarily effective.

ANS: C

Herbal preparations are regulated as food and nutritional supplements by the FDA. They do not require a prescription because they are not medications. Unfortunately, herbs are not under regulation by the government as drugs, and are not guaranteed to be natural, safe, or effective. This is one of the major disadvantages of herbal therapy.

8. A client asks the nurse to pray with him. The nurse is an atheist. Which statement by the nurse is the correct response?

a.

Yes, lets pray together.

b.

No, Im sorry, I cant do that.

c.

No, I dont believe in prayer.

d.

Ill hold your hand while you pray.

ANS: D

By stating that he will hold the clients hand, the nurse offers support for the clients choice without compromising his beliefs. The nurse should not participate in any activity that goes against his or her beliefs. The nurse should not just state that he or she cant do this or tell the client personal views or preferences.

9. The client has been diagnosed with cancer and is experiencing depression and insomnia as side effects of chemotherapy. The client tells the nurse that she has been supplementing her antidepressant medication with lavender oil and sandalwood but they arent working. Which statement by the nurse is the best response?

a.

Tell me more about exactly what you are taking, how much you take, and when you take the antidepressants and use the oils.

b.

Perhaps youre not using enough of the oil or are using it incorrectly.

c.

Ill speak with your doctor to get you some medication that you can take while continuing the aromatherapy.

d.

You dont want your doctor to put you on sleeping pills and antidepressants. Keep using them.

ANS: A

The nurse should continue the assessment of the client to determine exactly what medications the client is taking and the specific type of complementary therapy the client is using, to determine whether the regimen is dangerous.

10. The client is undergoing treatment for cancer and is experiencing a high level of anxiety. The client expresses interest in complementary therapies that might decrease the level of anxiety. Which action is the best choice for the nurse to implement with this client?

a.

Direct the client to an imaginative peaceful setting using imagery.

b.

Provide assistance in finding an acupuncturist.

c.

Suggest Tai Chi during chemotherapy treatments.

d.

Encourage the use of acupressure over tumor sites.

ANS: A

Nurses traditionally have used a number of mind-body therapies such as prayer, imagery, meditation, music, and pet therapy to decrease anxiety in clients. Acupuncture and acupressure are pain relief therapies that usually require special education. Tai Chi is a body-based therapy that requires energy that may not be appropriate during chemotherapy sessions.

By reducing physical, mental, and emotional tension, relaxation is believed to result in changes opposite those of the fight-or-flight mechanism. Relaxation is helpful during painful procedures but may not be helpful with certain mental health problems or unresponsive clients because relaxation requires action from the client to relieve the tension.

12. A nurse is assisting a client in preparing for surgery by using progressive muscle relaxation. Which rationale best supports the use of this therapy at this time?

a.

It rebalances or repatterns a persons energy field.

b.

It improves flexibility and assists with positioning during surgery.

c.

It applies pressure, releasing congestion and promoting energy flow.

d.

It uses intentional tensing and releasing of successive muscle groups.

ANS: D

Progressive muscle relaxation provides intentional tensing and releasing of successive muscle groups, thereby promoting relaxation and decreasing anxiety. Anxiety reduction would be the best rationale for a client preparing for surgery. The other statements are inaccurate descriptions of progressive muscle relaxation and its use.

13. A client tells the nurse that he or she is considering using herbal supplements. What is the nurses best response?

a.

Herbs are not classified as drugs in the United States, so there is no contraindication to using them.

b.

Herbs have pharmacologic effects on the body and can interact with some prescription medications.

c.

It is never permissible to use herbal supplements with prescription medications.

d.

I will refer you to an herbalist, who can help you decide which medications you can take.

ANS: B

Although herbs are not classified as drugs, they do possess pharmacologic properties. In caring for a client, the nurse should inquire whether the client takes herbal preparations and, if so, for what purpose. Many herbal preparations have not been adequately studied, and some can interact with prescription medications, causing toxic effects. The nurse should not refer the client to an herbalist. The client should be instructed that there are contraindications to herbal usage, but that herbs can be used with prescription medications, depending on the medication, the herbal substance, and the condition of the client.

14. A client who is status post aortic valve replacement takes sodium warfarin (Coumadin) daily and has started taking Ginkgobiloba. What is the priority action for the nurse to take?

a.

Encourage the use of Ginkgobiloba to enhance the clients systemic circulation.

b.

Assess the client for any bruising or petechiae.

c.

Explain that replacing Ginkgo biloba with garlic would be much safer.

d.

Assess for any forgetfulness or inappropriate speech.

ANS: B

Taking Ginkgo biloba with warfarin increases the clients risk of bleeding. Therefore, the client should be monitored first for bruising or bleeding associated with use of this combination. Ginkgo biloba is purported to reduce memory problems and dementia and has vasodilator properties, but these uses cannot be supported if the client is on an anticoagulant for the heart valve replacement. Garlic would not be a safer choice because it can act as an antiplatelet agent and would increase the risk of bleeding with warfarin (Coumadin).

15. Which statement indicates that the client needs further teaching about complementary therapy?

a.

Ive decided to use herb therapy for cancer treatment, so I can cancel my radiation treatments.

b.

Im hoping that massage therapy will help reduce the amount of pain medication I use for my myalgia.

c.

I think it helps me get better faster when I picture the drugs punching out the germs in my body.

d.

I intend to pray about my cancer treatment several times a day. It makes me feel so much better.

ANS: A

Complementary therapies are intended to be used with, rather than to replace, traditional forms of therapy to integrate mind, body, and spirit into the healing process. The client must have this information clarified, so that he will follow his recommended regimen for cancer treatment. The other statements appropriately indicate that the client understands the purpose of complementary therapy.

16. Which teaching strategy is appropriate for a client who wishes to use mind-body complementary therapy to supplement traditional treatment for cancer?

a.

Instruct the client to make a follow-up appointment with the health care provider after using mind-body treatments to assess the clients response to treatment.

b.

Instruct the client never to use alternative or complementary treatments for serious illnesses.

c.

Explain to the client that physicians and nurses are not prepared to recommend and monitor alternative treatments.

d.

Explain to the client that physicians and nurses do not incorporate such treatments into their practice.

ANS: A

Complementary or alternative treatments may be used in association with traditional therapy. The client who uses complementary or alternative therapy should be advised to make a follow-up visit to the health care provider to assess the clients response to therapy and to detect any adverse effects.

17. Which complementary or alternative therapy would the nurse recommend to a client with stiff joints to improve mobility?

a.

Imagery

b.

Animal-assisted therapy

c.

Tai Chi

d.

Aromatherapy

ANS: C

Tai Chi is an active holistic therapy that integrates body movements, concentration, muscle relaxation, and breathing to improve body function, such as flexibility and posture. Imagery has been used successfully to reduce pain, nausea and vomiting, and anxiety. Animal-assisted therapy generally is used with clients who need to improve motor skills or the ability to concentrate. Aromatherapy uses essential oils to achieve relaxation, improve concentration, and ease depression.

19. The nurse is working in the community and completes home visits with older adult clients. Which statement by a client demonstrates a need for further instruction about the use of complementary and alternative therapies?

a.

My doctor monitors my kidney function since I started taking calcium.

b.

I always talk to my doctor first before starting an herbal preparation.

c.

I heard that St. Johns wort is good for any type of depression.

d.

I may start a Tai Chi program to help with my mobility and lift my spirits.

ANS: C

The client needs some education regarding the use of St. Johns wort for depression. It is advisable to seek the advice of a physician and to be evaluated for psychotherapy and/or drug therapy. Often older women consume too much calcium, and this can result in renal calculi. It is recommended that the older adult should have calcium levels monitored, as well as kidney function. All clients need to inform their health care team about any use of herbal preparations because of possible interactions with medications and possible side effects. Tai Chi is to be encouraged in the older adult to improve physical and mental health.

1. During an initial health assessment interview, the nurse learns that the client is taking warfarin (Coumadin) for a history of deep vein thrombosis. Later, the client admits to taking several herbal preparations as well. Which herbal preparations would the nurse caution the client to avoid? (Select all that apply.)

a.

Ginkgo biloba

b.

Garlic

c.

Ginseng

d.

Zinc

e.

St. Johns wort

ANS: A, B, C

Ginkgo biloba may increase the anticoagulant effects of warfarin. Garlic and ginseng have been found to affect the international normalized ratio (INR).

2. The nurse wishes to start music therapy with an older adult client who has high anxiety and hypertension. What essential elements should be considered when music is used with this client? (Select all that apply.)

a.

Assess the clients preferences in choice of music.

b.

Use fast tempo music to energize and motivate the client.

c.

Consider rap music to provide diversion.

d.

Consider live or recorded music such as music performed on a harp.

e.

Consider generation-specific music.

ANS: A, D, E

In music therapy, the nurse is encouraged to provide generation-appropriate music and to evaluate the clients preference. Live harp music may have a calming effect with anxious clients. Rap music is not generation-appropriate for older clients. Music with a fast tempo may escalate the clients anxiety and increase blood pressure.